One of the most interesting exchanges in our first roundtable started with a challenge to the way healthcare measures success: why put so much attention on readmissions when we could be doing more to prevent the first hospitalization?
That question opened up a broader conversation about incentives, prevention, and what it takes to help people get the care they need before a problem gets worse.
On October 28, Marqi Medical hosted a small, independent peer discussion following the NAACOS Fall 2026 Conference. We talked about the upcoming LEAD Model, the realities of care coordination, where the pharmaceutical industry might contribute, and the practical role of AI.
People brought different experiences and sometimes different opinions. Rather than force a neat consensus, we wanted to share the perspectives that made the discussion worth having—and connect them to a few related topics from NAACOS.
1. LEAD offers an opportunity. Convincing practices to participate is another story.
The Long-term Enhanced ACO Design (LEAD) Model, launching January 1, 2027, was one of the first topics raised. The ten-year model aims to bring a wider range of practices into accountable care, including smaller independent practices and providers serving patients with complex needs.
A participant with experience recruiting independent practices described how difficult that work can be. Some physicians have been disappointed by earlier arrangements. Others need more time to understand the economics and what participation would actually require.
Payment timing matters, too. From that participant's perspective, the prospect of receiving money sooner, rather than waiting until well after a performance year for shared savings, can make a difference in how a practice evaluates the opportunity.
But financial incentives alone don't answer every question. Practices also need to understand the risk, the support available to them, and whether the model fits the way they care for patients.
Two NAACOS sessions—New Players, New Possibilities and The Next Decision Point: MSSP, LEAD, and the Financial Road Ahead—explored related decisions. Different patient populations, financial circumstances, and operating models can lead organizations to different conclusions about participation.
The question isn't just whether LEAD creates an opportunity. It's what practices will need to take advantage of it.
2. What if we spent more time preventing the first hospitalization?
The longest discussion of the afternoon challenged the industry's focus on hospital readmissions.
One view was that healthcare should do more to intervene before an initial hospitalization. Heart failure was the example: changes in weight, symptoms, and other indicators may signal that a patient needs attention before an avoidable emergency visit occurs. That creates opportunities for appropriate monitoring, outreach, and clinical care.
Another perspective was about the incentives. Readmissions are relatively straightforward to count, and hospitals face financial consequences for certain readmissions. That helps explain why they receive so much attention.
The conversation also included a more provocative argument: hospital-led organizations may face competing financial incentives when preventing admissions also reduces hospital revenue. One participant felt independent primary care groups can be better placed to focus on keeping patients out of the hospital.
That is a perspective on incentives—not proof that every independent ACO outperforms every hospital-led ACO.
Then came the difficult measurement question: how can an organization show that a hospitalization would have happened if it hadn't intervened? Historical costs and benchmarks can help estimate performance, but attributing a prevented event to any single action is hard.
NAACOS's Right Patient. Right Care. Right Time session raised a closely related issue: once a patient is identified as needing attention, what determines whether the right care can happen soon enough?
Prevention and readmission management aren't competing goals. Both matter, and not all hospitalizations are preventable. But the exchange was a useful reminder that finding risk is not the same as being able to act on it.
3. When care crosses organizations, who is responsible?
Care coordination sounds straightforward until a patient's next step involves several organizations.
Who follows up when a referral hasn't turned into an appointment? Who handles a transportation problem? What if a patient can't afford their medication, or a service was arranged but never delivered?
A strong view in the roundtable was that these responsibilities need to be clear from the beginning: is it the practice, the ACO, or a third party? Someone needs to know when a service was delivered, declined, delayed, or never provided.
Participants also discussed approaches already in use to track what patients actually receive. That's a more practical distinction than simply counting referrals or outreach attempts.
But there was a counterpoint. One participant argued that ACOs can sometimes become gatekeepers themselves. Too much control or too many approvals may get in the way of the people trying to solve a patient's problem.
So the challenge isn't just adding oversight. It's finding a balance between clear responsibility and enough flexibility to act.
This connected with NAACOS's Transitions of Care: Who's Driving the Bus? and Community Care Strategies to Support Duals and Other Complex Populations sessions, which explored the difficulty of coordinating medical and community services across different settings.
Those problems don't have one universal solution. Still, the discussion made clear why it matters to know who is handling the next step—and what happened afterward.
4. Where does pharma fit into accountable care?
The conversation took an unexpected turn when we talked about how the pharmaceutical and life sciences sector might contribute to accountable care.
The perspective offered was exploratory, not an official company position. Possible roles included disease-state education, better understanding unmet patient needs, and developing evidence tied to outcomes that matter to ACOs.
One question was whether research and evidence should pay more attention to events such as emergency visits, hospitalizations, and skilled nursing stays—alongside the clinical endpoints traditionally used to evaluate treatment.
Other views in the room recognized the potential, while acknowledging that manufacturers and ACOs don't always have the same incentives.
Medication affordability was part of the discussion, too. A treatment plan may make sense clinically, but if a patient cannot get the prescribed medication, the intended care may not happen.
A separate NAACOS session examined pharmacist-led medication optimization. That was not a session about pharmaceutical manufacturers partnering with ACOs, but it added another perspective on the importance of appropriate medication use, access, and evaluating outcomes. Observational or sponsored findings presented at conferences require independent scrutiny before broader claims about effectiveness or savings.
No one claimed to have settled pharma's future role in accountable care. The value was in hearing what different parts of healthcare might be able to contribute—and what evidence would make that contribution meaningful.
5. AI can do more. Should it?
The AI discussion ranged from drug discovery and rare-disease identification to the everyday administrative work that absorbs staff time.
One perspective was that repetitive work is an obvious place to start. Appropriate automation might reduce errors, incomplete work, and burnout, leaving staff more time for work that needs human attention. Those were expectations discussed at the roundtable, not results measured there.
Another important point was less glamorous: AI depends on reliable data and the work of connecting systems. Without that foundation, a new tool may simply introduce different problems.
Participants also questioned what success should look like. If a tool is introduced to improve annual wellness visits or transitional care follow-ups, should it be judged by how many messages it sends—or by whether more patients actually receive the intended care?
There was discussion of care teams potentially handling larger patient populations with better tools. That remains a goal to test, not an established result.
Human oversight was another part of the conversation, particularly when AI-supported decisions could affect patient care.
NAACOS's Using AI to Drive ACO Performance session explored related questions about data, governance, implementation, and operating costs.
The perspectives weren't identical. Some focused on what increasingly capable AI could eventually do; others wanted the industry to solve simpler problems first. Both were worth hearing.
What we're taking into the next conversation
Our first roundtable didn't produce a single answer—and that wasn't the point. Participants questioned how payment models shape decisions, how to measure prevention, whether ACO oversight sometimes slows progress, and how technology can help without adding another layer of work.
The conversation also reminded us that different organizations can see the same problem quite differently. That's a good reason to bring them into the same discussion.
December 4 will be a new conversation, not a replay of October. Drawing on themes in the [FLAACOs 2026](https://www.flaacos.com/flaacos/conference/agenda) and [HLTH USA 2026](https://hlth.com/events/usa/agenda-at-a-glance/) programs, we'll ask three fresh questions:
Where should ACOs invest in 2027—and what should they stop spending money on?
What's the biggest opportunity to improve care for high-cost, complex patients?
With so much AI and healthcare technology coming to market, what's actually worth adopting?
Whether you attended either conference or not, we'd welcome your experience and your perspective. It's a small, independent peer discussion—not a sales presentation.
Join the December 4 roundtable
About this article: This is an editorial account of a small professional roundtable hosted independently by Marqi Medical on October 28, 2026, with additional context from selected NAACOS Fall 2026 sessions. Perspectives are paraphrased and anonymized; they are not necessarily the views of Marqi Medical, the participants' employers, NAACOS, or the industry as a whole. Conference material is clearly distinguished from the roundtable discussion. Marqi Medical's October event was not affiliated with or endorsed by NAACOS.